Erectile Dysfunction

Erectile dysfunction, which some people still refer to as ‘impotence’ is the inability to obtain and maintain an erection suitable for satisfactory sexual activity and is something that can occur following treatment for male cancer. There may be varying degrees of erectile dysfunction and these can be measured with the help of The Sexual Health Inventory for Men (SHIM), see below.

To work out your particular level of erectile function/dysfunction, add the numbers corresponding to questions 1-5.

The Sexual Health Inventory for Men further classifies erectile dysfunction as:

1-7 Severe 8-11 Moderate 12-16 Mild to Moderate 17-21 Mild ED

Treating Erectile Dysfunction

There are several treatments available to help with this problem. Trying them in a stepwise approach is a good way to see what will work for you. Your partner may have anxieties about you using particular treatments due to a fear of side effects. Talk about this together to help relieve anxieties.

Pelvic Floor Exercises

The pelvic floor supports the bladder and the bowel and is made up of layers of muscle that stretch from the tailbone at the back to the pubic bone in front. Research has shown that men who practice these may notice an improvement in their erections. They are especially important to perform after surgery to remove the prostate gland (prostatectomy).

How to find the pelvic floor muscles

To find your pelvic floor muscles, you should sit or lie comfortably with the muscles of your thighs, bottom and stomach relaxed.

Muscles around the anus

You should then tighten the ring of muscle around your anus without squeezing your bottom as if you are stopping diarrhoea or wind. Do not hold your breath.

Muscles around the urethra

To feel these muscles imagine you are trying to stop your flow of urine mid-stream, and then restart it. If correct you should feel the base of your penis move up slightly towards your abdomen.

Tighten and draw in the muscles around the anus and urethra, lifting the muscles up inside. Count to five, then release and relax. You should have a ‘definite feeling of letting go’. Repeat this up to maximum of 8 to 10 squeezes, resting for 10 seconds after each tightening of the muscles. You should follow this by 5 to 10 short, strong squeezes in quick succession.

Repeat the slow and quick squeezes around three to four times a day.

If you are not sure whether you are performing the exercises correctly you could ask your GP or hospital consultant to refer you to a physiotherapist or continence specialist.

Oral Medication

Oral medications such as Viagra (sildenafil citrate), Cialis (tadalafil) and Levitra (vardenafil) are often effective treatment options. They have slight differences in how long they will remain in your bloodstream and therefore work. After taking one of these medications, usually within half an hour to an hour WITH SEXUAL STIMULATION men may be able to get an erection. Sexual stimulation is important as they are not effective without it. After orgasm the erection will fade as it would normally. This treatment may not be advisable for men who have ongoing cardiac or heart problems and men may not be able to take these tablets if they are on nitrate drugs for angina and highblood pressure. No drug treatment or any of the treatment below should provide an erection that lasts for more than four hours. That is considered a medical emergency and is called a priapism. If it happens urgent medical help should be obtained.

Other Treatments

MUSE (intra-urethral alprostadil) is a small pellet that is inserted down the opening at the end of the penis. A plastic pre-filled applicator is used for administration. An erection achieved with this treatment will remain after orgasm and not subside until the drug has ‘worn off’, around 30-60 minutes. If practising oral sex a condom should be warn to prevent any possibility of your partner swallowing the pellet. It can cause some tenderness and discomfort in the penis.

Vitaros– This is a cream that contains alprostadil and is administered in a similar way to MUSE by applying it to the surface of the penis.

Caverject Dual Chamber or Viridal Duo (intracavernosal alprostadil) are injections that are self-administered into the base of the penis to obtain an erection. A very fine needle is used. Patients describe the feeling of having the injection as ‘pricking a finger with a rose thorn’. To achieve the best result, Caverject must be injected slowly. This treatment is not suitable for men who are taking anticoagulant medications such as Warfarin.

A vacuum constriction device is a mechanical aid that can help to establish an erection. The erection is maintained by putting a constriction ring at the base of the penis to hold the erection. The ring should not be in place for more than 30 minutes. As soon as this ring is removed the erection subsides. Vacuum devices may not be suitable for men who are taking anticoagulant medications such as Warfarin. Although there are many such devices available for men it is important to use a medically developed device and not one bought from a sex shop. These should be available on prescription from your GP as men who have had pelvic surgery or radiotherapy are entitled to a vacuum device.

Penile implants can be a satisfactory option if all previously mentioned therapies have failed or are not providing the desired results. Discussion with a urological surgeon who is familiar with inserting these is essential as the operation can be quite technical. The implants can be either malleable or inflatable.

Psycho Sexual Therapy

Psycho sexual therapy is a method of talking about sexual problems which may result from psychological barriers which may have been caused by a change to body image from cancer treatment or sexual well-being. Talking to a specialist counsellor may help overcome some of these problems. It is very important however that both men and their partners are involved in this type of therapy. The specialist health care team should be able to refer men to such a counsellor or give details of local organisations that may offer this service.